SLEEP

One of the biggest challenges many parents of new babies face is helping their baby to develop a sleep routine and teaching her how to sleep for long periods by herself. Like us, babies sleep in cycles but their cycle is about 45-50 minutes – half of ours. Since brief waking after each cycle is part of a normal sleep pattern, babies will wake during the night. It takes time for them to learn to sleep for longer at night and sleep less during the day.

Like adults, different babies need different amounts of sleep. Some babies will sleep a lot more and others slightly less than expected. In the first few weeks, the night sleep may be broken into blocks of 3-4 hours as the baby wakes for feeds. By six months, around 50% of babies will sleep for approximately six hours straight at night.

Some parents have their baby in a bassinette or camp cot near their bed for the first few months so that they can hear their baby waking and get to them quickly to feed. Others prefer not to have their baby in their room because their sleep is disturbed by the sounds their baby makes. Some parents have their baby sleep in their own bed. If you choose to do this, make sure your mattress is firm and your baby will not get too hot. It is also important to be aware of the risks of rolling onto a baby or trapping a baby under pillows or near a wall if they sleep in the same bed as an adult. Bed sharing is not advised for parents who smoke, as the risk of SIDS (Sudden Infant Death Syndrome) is increased. Other concerns are that infants have less deep sleep, wake up more on nights when they share a bed, may resist being moved into their own cot and may need a programme to help them learn to sleep alone.

Wherever your baby sleeps initially, by 5 months you should try to move him to where you would like him to sleep for most of his babyhood. Most babies do not develop night sleep cycles until after 5 months, and it’s better for him to learn to drift from one sleep cycle to the next in his actual room rather than having to relearn this skill in a new environment.

Room temperature

Try to keep the room temperature constant and dress your baby so that he will not be too hot or too cold. When checking your baby’s body temperature, feel the back of his neck or his tummy. A good rough guide is to dress him in the same number of layers as you are wearing, with one extra. Babies are often too cold at night, so using a warmer sleeping bag, extra blanket or making the room warmer often helps them sleep better. If you find your baby wakes each night at 4am or 5am, he is most likely cold as this is the coldest part of the night.

Work towards a regular pattern

Routines may sound tedious and limiting but they actually make life easier. They help babies to feel safe and secure as their needs are being met and there is no reason to cry. Most babies start to develop a pattern to their sleeps over the first two weeks. Initially, the times your baby sleeps and feeds may vary a little each day, but they will become more regular as your baby gets older. The goal is to develop a regular sleeping and feeding pattern over the first 3 months, such as sleep-wake-feed-quiet play-sleep and so on.

Try to have regular times for putting your baby down to sleep and be sure to look for signs that your baby is getting tired. Most babies will begin to show tired signs with 10-30 minutes following their feed. These may include:

Jerky movements of arms and legs

Clenched fists

Irritability/crying

Rubbing eyes

Yawning

You can encourage naps by putting your baby in a comfortable place to sleep such as their cot or bassinette and try not to let them fall asleep just before a feed time, or when their nappy needs changing, as they will not sleep for long. Once a daily pattern has developed, try to keep to this routine and avoid disrupting your baby’s usual sleep times.

Develop a bedtime routine

Start to develop a bedtime routine for your baby which will give him clear signals that it is nearly time to go to sleep. A good routine involves having quiet activity (with minimal stimulation) just before your baby’s nap or bedtime. For bedtime, develop a routine like feed, bath, dressing in pyjamas, a story or song, and goodnight kisses. This can help settle children for bed. Put your baby in their cot, dim the lights and use a soft voice. Say goodnight and walk out before your baby falls asleep. Once you have set up a routine, follow it each night.

Swaddle your baby

It is normal for babies to make jerky movements when they are tired or trying to fall asleep. This is caused by their startle reflux, which is there until they are 3-4 months old. Sometimes your baby’s jerky movements may wake or frighten them and this is why swaddling a baby is recommended.

Swaddling a baby also plays an important role in reducing the risk of SIDS because it helps to keep him in the safe sleeping position. Swaddle your baby until you notice he is trying to roll swaddled and then slowly start reducing the swaddling.

Put your baby to bed awake

Enabling your baby to settle herself is very important in establishing successful sleep patterns. If you rock, cuddle, feed or give your baby a dummy/pacifier to go to sleep, then this is what your baby will expect when she moves into the light stage of the sleep cycle. Instead of resettling, your baby will wake up looking for you or the sleep aid, and then cry to be rocked, patted or fed back to sleep or to have her dummy put back in.

Your baby needs to learn to fall asleep without you comforting her. Whenever possible, put your baby to bed while she is still awake and try to avoid being with your baby when she falls asleep. If your baby starts to fall asleep while feeding, stop feeding and put her to bed. Simply try to put her down earlier next time, before she falls asleep.

Teaching your baby to self-settle is not easy initially and you need to be prepared for a bit of initial protesting and crying. The end goal is for your baby to learn to settle herself to sleep without you doing anything. Make sure your baby is well fed, winded and has a clean nappy. Swaddle her and put her to bed. Try to relax and calm your baby while she is in her cot by patting her calmly on the nappy area, stroking her head or talking softly and calmly to her, limiting eye contact. Leave your baby to sleep on her own once she is quiet and relaxed. Your baby may very well start to protest when you leave the room, but will soon settle.

Wait and listen when your baby wakes

Rushing to comfort babies may rouse them further rather than settle them, and may prolong night waking. If you hear your baby stirring or grizzling, listen and wait for a short period (a minute or so) to see if she will settle herself. Going to your baby may disturb her unnecessarily. Do, however, try to respond before your baby becomes very distressed, as she will then be more difficult to resettle.

Emphasise the difference between night and day

When you hear your baby wake in the morning, do not rush in straight away. Gradually increase the amount of time before you go to your baby unless he is distressed. Your baby may fall asleep again or play quietly with some safe toys in the cot. Set a time to get up, say 6:00am, and try to stick to it. When you go to your baby in the morning, use a different greeting than when you go to your baby during the night.

Avoid darkening the room during the day and don’t reduce noise levels. Have some activities for when your baby is awake and try not to let your baby sleep for more than 3-4 hours at a time during the day. Remember though, that keeping your baby awake all day will not help him sleep better at night. Babies do need their daytime naps.

If you go to your baby during the night to feed or help him settle, talk in a low, quiet voice only if necessary and avoid eye contact. Do not play with him or turn on the lights. Only change your baby’s nappy if absolutely necessary.

A number of things can affect the way your baby settles and sleeps. Wind, thrush, nappy rash and constipation can make your baby so uncomfortable that it’s almost impossible for him to get to sleep.

1. Winding
Your baby taking in air while he is feeding causes wind. When this air accumulates in the tummy, you may end up with a very unsettled baby. One way to wind your baby is to hold him on your lap, with one hand supporting his chin and under his arms, and pat or rub his back. Alternatively, lay his head and arms over your shoulder and again pat or rub his back. If you still can’t get a burp up, try laying your baby down for a minute and then lifting him up again. The burp often comes up with a bit of help from gravity.

2. Colic
This usually refers to a pattern of unsettled behaviour and continuous crying in some babies in the first few months of their life. It seems to occur in about 20 percent of all babies and is equally common in breastfed and formula-fed babies.

Colic usually starts in the second or third week of life and usually gets as bad as it is going to get by 6 weeks. The problem usually diminishes by 12 weeks and at 3 months most colicky infants appear miraculously cured.

The cause of colic is still not known but many colicky babies do seem windy and studies show that reducing the wind seems to reduce the discomfort for many. There is a medicine that contains the active ingredient simethicone that does seem to help reduce or alleviate symptoms in colicky babies. The product is not absorbed by the body and is therefore completely safe with no side effects. It can be bought over the counter. If your colicky baby seems windy, ask your doctor about using this product.

3. Hiccups
Hiccups are normal in a baby and often happen after a feed. Babies don’t seem to be bothered by hiccups so, if it is sleep time, put your baby down as normal. If your baby does seem upset by the hiccups, try giving some gripe water.

4. Posseting
This is when a baby brings up a little milk after a feed. It is sometimes caused by not being winded enough during and after a feed. The extra air comes up so fast that it brings up milk ahead of it. In these cases, posseting can be reduced or stopped altogether by winding your baby. If posseting occurs only on the odd occasion and your baby is still gaining weight sufficiently then don’t worry about it. If your baby is not gaining weight and the posseting is becoming very frequent, you should consult a doctor as he may be suffering from reflux.

5. Reflux
When a baby has a weak sphincter muscle at the top of the stomach, it allows the contents of the stomach to go back up into the baby’s oesophagus. In serious cases, the bottom part of the oesophagus becomes inflamed and if left untreated, inflammation and ulcers in the oesophagus can cause scarring. This can lead to difficulty in swallowing.

Babies suffering from reflux are often difficult to feed, constantly arching their backs and screaming during and after a feed. Consult your doctor if you think your baby may have reflux. Things to help a baby suffering from reflux are:
• Keep baby upright during a feed as gravity helps prevent regurgitation
• Burp baby often during a feed
• Prop up one end of the cot and put your baby to sleep with his head at the higher end
• Avoid lifting baby’s legs during a nappy change. Roll him onto his side instead.
• Do not feed your baby more than every 4 hours if he is over 8 weeks old
6. Constipation
Some babies over 3 months can go as long as 4 days without having a bowel movement. There is nothing to worry about as long as your baby appears comfortable and the stools are soft when they do appear. A baby is usually only considered to be constipated if she goes more than 7 days without a poo, and when it does come, it is hard and pellet-shaped.
Constipation is rare in babies up to 3 months, whether breastfed or formula-fed. Symptoms of constipation in an older baby who has started solids may include:
• Irritability
• Abdominal pain and gastric discomfort
• A hard abdomen which softens after a bowel movement
• Blood-streaked stools (usually due to rectal fissures caused by passing hard stools)
• Hard-to-pass pellet-like stools.
If your baby does appear constipated, try offering up to 30ml of cooled, boiled water from a bottle between milk feeds. If this does not help, try adding a teaspoon of brown sugar to the water. If your baby is on solids, try giving her prune juice or apple juice.

7. Thrush
This is an infection caused by a yeast germ called Candida. Thrush is more common in the mouth in babies but can develop in the vagina and around the bottom. It is equally common in boys and girls. If your baby has thrush in the mouth, she will feel sore and uncomfortable and may suddenly be harder to feed. If her mouth appears a brighter red and you can see white spots or a white coating on her tongue, she may have thrush.

If you suspect thrush, you need to see your doctor to get a suitable treatment. Avoid using dummies while your baby has thrush and pay even more attention to hygiene and sterilising everything that come in contact with your baby’s mouth including teats.

8. Nappy rash
This is skin irritation caused by urine, bowel movements or other irritants usually around the nappy area. Good nappy changing habits can limit nappy rash, but most babies get some nappy rash no matter how well they are cared for. Nappy rash can be very painful and a baby with nappy rash can be very unsettled. Simple nappy rash is a burn-like rash on the skin in the nappy area. The skin appears red, swollen, moist and slightly rough or scaly. Skin in the creases is usually not affected.

Nappy rash can become infected with a fungus called Candida (thrush). This usually causes a brighter red, shiny rash with sharply outlined patches, often with smaller spots outside the main area. Nappy rash can become infected with bacteria, which may cause weeping or yellow crusting of the rash area and fever.

Most cases of simple nappy rash resolve in 2-3 days with good skin care.
• Check nappies frequently. Change wet or dirty nappies straight away to reduce the time the irritated skin is in contact with urine or bowel movements.
• Gently clean the baby’s bottom at each nappy change with plain warm water using a soft cloth or cotton wool. If this does not clean well enough, use a non-drying, non-soap cleanser. Avoid soap, talcum powder and wipes as these may further irritate the skin.
• Pat skin dry and leave completely uncovered until completely dry.
• Apply a water-repellent, soothing barrier cream or ointment after cleaning baby’s bottom, at each nappy change. This provides a water-resistant protective layer and helps soothe the baby’s skin.
• Leave the nappy off as much as possible to expose the skin to the air. Take care if you are outdoors as a baby’s skin is very sensitive and burns very easily.
• Non-soap bath solutions and oils can be added to the baby’s bath to help settle skin irritation.
• Give paracetamol for pain relief if your baby is unsettled.